Provider Demographics
NPI:1992588297
Name:ANDERSON, ELIZABETH GRACE (RD)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:GRACE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:BAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1723 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-3505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1723 2ND AVE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-3505
Practice Address - Country:US
Practice Address - Phone:985-773-8534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered